High School Counselor Use Only:

________Date Received
________Transcript
________Assessments
________Attendance
________IEP/504/ELL (if applicable)

State Testing ID (If not on HS transcript)

1312 South Sangre Road Stillwater, OK 74074 www.meridiantech.edu 405.377.3333 Fax: 405.377.2076

High School Student Application for Admission

2018-2019 New Student
(All fields required or write N/A If Not Applicable)

First Name Middle Name Last Name

Date of Birth Gender: F  M  T-Shirt Size (for free t-shirt) S M L XL 2XL  3XL
(MM/DD/YYYY)

Cell Phone Email

Mailing Address City State Zip

Number Street

High School Current Grade (circle one) 9 10 11 12

Program (First Choice) see p. 4

Program (Second Choice) see p. 4

I Prefer to Attend: AM (7:50-10:40 AM) OR PM (12:45-3:35 PM) Willing to attend either session? YES or NO
(Please keep in mind your class commitments: band, sports, etc)

Pre-Engineering, BioMedical, Cosmetology, and first year Health Career students should not complete this section.

High School Math Courses – If you need to take math at Meridian Technology Center, please mark the course needed.
Algebra II Math of Finance Geometry Pre-Calculus

High School Counselor or Administrator signature (required to enroll in math):

Releases, Policies and Procedures

I hereby give my permission for my child’s high school to release grades, attendance records, and achievement test scores to Meridian Technology
Center. I also give permission for the high school to release confidential records contained in my child’s Individualized Education Program (IEP), if
applicable. I understand that all records are confidential and will only be reviewed by Meridian staff who serve my child. I understand that parents or
guardians of individuals under 18 years of age have the right to request records. Individuals 18 years of age or over must give permission for
information to be released to parents, according to the Family Rights & Privacy Act.

A student enrolled at Meridian Technology Center gives the school permission to utilize the student’s photograph and name in public relations efforts
and promotional materials including but not limited to social media, the website, radio promotions, newspaper and videos unless written notice is
given to the Career Planning Center each school year that permission is withheld.

Upon approval by the Career Planning Center for acceptance in a program at Meridian Technology Center, the applicant and the parent/guardian do
hereby agree to comply with Board-approved policies and procedures including, but not limited to, the student handbook.

Signature of Student Signature of Parent/Guardian Date

Application will not be considered for acceptance until signed. Completion of this application does not guarantee admission.

Meridian Office Use ONLY:

Acpt __________ App entd_________ Add/Emg Cont_________ Enrl Code:
WL ___________ Bio entd__________ Health/N/ACT_________
Denied _________ Okst/bd/ss________ Interest_________ Revised 1/11/18

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Father/Guardian 1 First Name Last Name

Father/Guardian’s Cell# Home# Work#

Mailing Address City State Zip

Number Street
Email Address Parent Portal access for grades and attendance? Yes___ No ____

Mother/Guardian 2 First Name Last Name

Mother/Guardian’s Cell# Home# Work#

Mailing Address City State Zip

Number Street
Email Address Parent Portal access for grades and attendance? Yes___ No ____

Student Father/Guardian 1 Mother/Guardian 2

We may use some or all of the following ways to
contact you in an emergency and occasionally for Text   
Meridian events. Please mark the ways you would like Cell Phone   
to be contacted. Standard text message rates may Home Phone   
apply based on your cell phone plan.
Email   

MEDICAL INFORMATION
Emergency contact (other than parents) Relationship
Cell# Home#
List medications student is currently taking

List medications to which student is allergic

List any physical disabilities Is student diabetic?

Family Doctor Phone# Date of last tetanus shot

Insurance Company

Policyholder’s name Policy Number

I understand that Betadine (an iodine-based antiseptic cleanser) is routinely applied to cuts when a student receives a small injury at
Meridian Technology Center.

 I do wish to be treated. I am not allergic to Betadine.  I do not wish to be treated. I am allergic to Betadine.

PERMISSION FORTECHNOLOGY
MERIDIAN EMERGENCY MEDICAL
CENTER CARE
I hereby give permission to Meridian Technology Center to obtain emergency medical care for any serious injuries incurred by above-
named student while at school or on a school-sponsored activity. I understand billing for said medical care will be sent to me.

Signature of Parent/Guardian or Student (18+) Date

PARENT/GUARDIAN PERMISSION FOR EXCURSION

The undersigned, a parent or guardian of__________________________________________, a student at Meridian Technology

Center, requests that the said student be allowed to participate in field trips within the Meridian Technology Center District. In the case
of an Out-of-District Excursion, a permission form will be given to the student requesting permission from parent or guardian.

___________________________________________________ ______________________________
Signature of Parent/Guardian Date

RELEASE OF STUDENT INFORMATION TO PARENT OR GUARDIAN

For students 18 years of age or older

I hereby give my permission to Meridian Technology Center to release information about my grades and/or attendance records to my
parent(s) or guardian(s). This release remains in effect until revoked in writing.

_________________________________________ ______________________________
Signature of Student (18+) Date

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 WORKKEYS ASSESSMENT
Meridian students take the WorkKeys assessment as part of their training program. You can learn more about WorkKeys on our
website. WorkKeys scores are uploaded to the Oklahoma Department of Commerce and the Oklahoma Department of Employment
Security (Oklahoma Job Link/Workforce Oklahoma). By signing below, I give permission to release my results to those agencies. I also
understand that my results will be stored in a secure database and will only be accessible to employers if I give my certificate number to
an employer.

Signature of Parent/Guardian or Student (18+) Date

PERMISSION TO DRIVE OR RIDE

Students from the following high schools are not permitted to drive to Meridian: Carney, Glencoe, Guthrie, Morrison and Pawnee. They
may only ride the bus. (Unless certain circumstances arise, then parent signature is required below.)

Will student drive or ride to Meridian? Yes No Bus only

Signature is required for high school student wanting to drive or ride with another student. I, the parent or guardian give
permission for my child under 18 years of age be allowed to drive or ride via private vehicle to and from Meridian Technology Center. I
further agree that neither the home high school, Meridian Technology Center nor any of its employees shall be held liable for any injury
to the student from such transportation.

Signature of Parent/Guardian
BEFORE THE INTERVIEW

Student - Please respond to the following questions in your own handwriting using complete sentences. Be prepared to discuss your
responses with the Meridian Technology Center admissions representative during your interview.

1. Why are you interested in the program you chose?

2. Describe a job you could have after completing the program.

3. Describe any classes, work, or life experiences that relate to your career.

4. How would your teachers describe you?

5. What are your strengths and weaknesses?

6. What are your favorite and least favorite high school subjects? Why?

7. Why should we choose you for our program?

8. If there is not room in the program you want, do you have a second choice? Why would you choose that program?

9. DIGITAL MEDIA ONLY: Please describe your computer and artistic skills.

10. COSMETOLOGY ONLY: Please describe how you would build a good relationship with someone.

11. COSMETOLOGY ONLY: What is good customer service to you?

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 Programs Available

Please place a 1 next to your 1st choice and a 2 next to your 2nd choice (if applicable).

_____ Air Conditioning & Refrigeration

_____ Automotive Technology

_____ Biomedical Sciences - STEM Academy *Must complete additional application materials

_____ Business Tech – Accounts Payable/Receivable

_____ Business Tech – Administrative Assistant

_____ Business Tech – Entrepreneur

_____ Carpentry

_____ Culinary Arts

_____ Cosmetology *Must complete additional application materials

_____ Collision Repair Technology

_____ Computer Aided Drafting (CAD) – Architectural

_____ Computer Aided Drafting (CAD) – Mechanical

_____ Digital Media – 3D Animation

_____ Digital Media – Digital Video Production

_____ Digital Media – Graphic Design Specialist

_____ Digital Media – Web Designer

_____ Electrical Technology

_____ Energy and Power

_____ Facilities Management (PM only)

_____ Health Careers *Must complete additional application materials

_____ Information Support & Networking Systems

_____ Masonry (AM only)

_____ Pharmacy Technician (Seniors only) *Must complete additional application materials

_____ Product Development and Machining

_____ Pre-Engineering – STEM Academy *Must complete additional application materials

_____ Precision Metal Fabrication

_____ Welding Technology

Meridian Technology Center will not discriminate in its programs, services, activities or employment because of race, color, sex, pregnancy, gender, gender expression
or identity, national origin, religion, disability, veteran status, sexual orientation, age, or genetic information in its programs, services, activities and employment.

Jeremy Zweiacker has been designated to handle inquiries regarding the district’s non-discrimination policies including Section 504/Title II of the Americans with
Disabilities Act, Title VI of the Civil Rights Act, Title IX, the Age Act and inquiries from individuals who have experienced discrimination not listed above. She can be
reached at Meridian Technology Center, 1312 South Sangre Road, Stillwater, Oklahoma, 74074-1899, or by phone at (405) 377-3333. Outside assistance may be obtained
from the U.S. Department of Education Office for Civil Rights at One Petticoat Lane, 1010 Walnut Street, Suite 320, Kansas City, MO 64106, or by phone at (816) 268-
0550, fax at (816) 268-0599 or email at OCR.KansasCity@ed.gov.

All technology center employees and students will be provided with age appropriate education regarding types of discrimination, harassment and bullying. Students and
employees will also be advised of the technology center’s expectations regarding appropriate conduct. Any student who is experiencing difficulty fully accessing the
technology center’s education programs should contact the coordinator so a success plan can be developed for the student.

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